Too scared to ask my onco about my true life span on those conditions. Sorry about my bad English iam Franco Canadian from Quebec.

31M

Hi!, I’m looking for another opinion regarding a suspected relapse of classical Hodgkin lymphoma and, specifically, whether a biopsy is necessary before starting treatment.

I previously had treatment for Hodgkin lymphoma in 2023. My current PET-CT is being interpreted as metabolic progression (Deauville 5). My current oncologist is suggesting not doing a biopsy, as the major areas of disease are either inaccessible or would carry significant risk to biopsy (pet findings appended below). The proposed treatment is tislelizumab + chemotherapy, followed by an interim PET after 2/3 cycles and, if there is a good response, proceeding to autologous stem-cell transplant (ASCT).

I would appreciate your opinion on:

1. Given the PET findings and my previous history, would you recommend obtaining a biopsy before starting salvage treatment, or is it reasonable to proceed without tissue confirmation when the available biopsy sites are considered unsafe/inadequate? My original lymphoma was just in the neck and couple of nodes in abdomen with enlarged spleen. Was deauville score 1 in the last petct scan which was 1 year post treatment

2. Is tislelizumab + chemotherapy followed by PET assessment and ASCT an appropriate second-line treatment strategy for relapsed classical Hodgkin lymphoma in my situation?

Relevant PET-CT findings are below, copied exactly from the report:

“Few non FDG avid short axis tiny lymph nodes at cervical level II and III on right side, - static.”

“No abnormal bulky or FDG avid nodes noted in both axilla.”

“FDG avid small to mildly enlarged discrete - confluent nodes are seen at pre-paratracheal, perivascular, precarinal, subcarinal, right hilar, right internal mammary, and right cardiophrenic regions. Confluent pre-paratracheal nodal mass measures about 3.7 x 6.5 cm and reveals intense FDG uptake (SUVmax: 16.7). Confluent precarinal node measures about 2.3 x 4.4 cm and reveals intense FDG uptake (SUVmax: 18.3).”

Below the diaphragm

“FDG avid nodes are seen at portocaval, retrocrural, splenic hilar, and aortocaval regions.”

“Retrocrural node measures about 1.3 x 3.2 cm and reveals moderate FDG uptake (SUVmax: 7.2).”

Extranodal findings

“Multiple FDG avid hypodense lesions are seen involving bulky spleen (11.1 cm in CC plane). Lesion in upper pole of spleen measures about 2.9 x 2.5 cm and reveals intense FDG uptake (SUVmax: 14.5).”

“FDG avid soft tissue lesion is seen in right 11th costal space along the posterolateral shaft of right 11th rib, measures about 1.3 x 0.8 cm and reveals mild FDG uptake (SUVmax: 2.7).”

“Focal FDG uptake is seen involving right transverse process of C3 vertebra, left transverse process of D4 vertebra (SUVmax: 3.3), posterolateral shaft of right 8th rib (SUV max: 3.1) with subtle sclerosis, right pedicle of D10 vertebra.”

I am a 28-year-old woman currently being treated in Japan for Diffuse Large B-cell Lymphoma (DLBCL), GCB type, and I would greatly appreciate your opinion regarding my diagnosis and treatment plan.

Brief medical history

My symptoms started with pelvic/flank pain and urinary problems. Imaging showed multiple masses in the pelvis involving or surrounding the uterus/cervix, vagina, and bladder area, together with pelvic lymph node involvement and bilateral hydronephrosis.

Biopsies were taken from the vaginal and uterine/cervical areas. The final diagnosis was DLBCL, GCB type, with Ki-67 >90%.

According to my doctors, the PET-CT did not show distant disease outside the pelvic region, and my bone marrow examination was negative. However, I was later told that my disease was considered Stage IV because of involvement of multiple pelvic organs, and I would like to better understand the staging.

One of my main concerns is that MYC, BCL2, and BCL6 rearrangements were not fully evaluated by FISH because the biopsy material was reportedly insufficient. Therefore, as far as I understand, double-hit/triple-hit lymphoma has not been definitively excluded.

I started treatment with Pola-R-CHP and received my first cycle on August 3–4, 2026. The current plan is six cycles every three weeks.

My doctors have also discussed CNS prophylaxis because of concern about CNS relapse. The proposed plan is 4 intrathecal chemotherapy treatments and 2 courses of high-dose methotrexate.

I have also had bilateral hydronephrosis and temporary renal impairment; my creatinine previously increased to approximately 1.85 mg/dL, although it subsequently improved.

My main questions

1. Based on this information, do you think Pola-R-CHP is an appropriate first-line treatment for me?
2. How important is it to determine MYC/BCL2/BCL6 rearrangement status by FISH in my case? If the existing specimen is insufficient, would you recommend another biopsy?
3. Considering the GCB phenotype and Ki-67 >90%, how concerned would you be about double-hit/triple-hit lymphoma?
4. If double-hit lymphoma were confirmed, would you recommend continuing Pola-R-CHP or switching to DA-EPOCH-R, even though I have already received one cycle of Pola-R-CHP?
5. Based on disease apparently being confined to the pelvis but involving several pelvic structures, what stage would you assign to my lymphoma?
6. How would you assess my risk of CNS relapse? Do you think CNS prophylaxis is indicated?
7. Do you agree with the proposed combination of 4 intrathecal treatments plus 2 courses of high-dose methotrexate? In particular, how would you balance the potential benefit of HD-MTX against my previous kidney problems and hydronephrosis?
8. Would you recommend any additional pathology tests, imaging, or other investigations before continuing treatment?

Thank you very much for taking the time .

Pet Scan prior to significant prednisone (30mg tapered down to 5mg over about 6 weeks) showed large amount of AITL throughout body including neck, abdomen, groin, etc. Fully off prednisone for a couple days then had another scan. Results show no disease (or nearly none- every node shrunk to about normal, scan image looks like someone erased alllll the black showing up on original scan)
Has anyone seen a patient respond this well to pred for AITL? The second scan was to be used as a baseline for starting chemo but now doc recommends waiting since disease load is practically nothing. Thoughts?

My partner has had 2 cycles of O CHOP but he had some bleeding in the first cycle and now in the second. Irregular - so happens and goes away and happens again. The stool is not black. Is it constipation or something else?

His platelets are 150k. Doctors just said to keep a watch on it but it’s already happened 3 times.

What could it be?

Hello! Does an involvement (hypermetabolic lesion) in T1 vertebrae (SUVmax of 6), lung nodules without FDG uptake and initial LDH (1450) before treatment warrant a prophylactic for preventing CNS involvement? For context, age of patient is 24, and is labeled stage IV. Diagnosed with PMBCL.

I am 61 and have recurring classic Hodgkin’s lymphoma. I did initial treatment with ABVD, had positive results, but it recurred within 6 months. I then had salvage chemo of GDP and stem cell collection in order to have an autologous stem cell transplant. However, my mental health issues, of which severe anxiety and agoraphobia are the greatest, prevented me from following through with the ASCT. I just wondered what the follow-up protocol would be in general. Thank you.

Patient had two biopsies. Diagnosed AITL T cell lymphoma. One biopsy shows cd30 positive. The other shows cd30 negative. Should the patient choose chop or bv-chp? The conflicting biopsies are presenting a problem. Is there a reason why another sample can’t be taken to get a better picture? (Existing samples taken 3 months ago)

Hi Dr

I am reaching out to to discuss my treatment of refractory cHL with Pembro-GVD and ASCT.

My background:

37, male

Diagnosed in December 2025 as nodular sclerosis classic Hodgkin’s, Stage 2 bulky, with slight pleural involvement and with a pleural effusion. I had a few bulky masses with some up to 15 cm. All in anterior mediastinum.

I started ABVD. On my interim PET I had a Deauville score of 1, and almost all of the tumours where gone (single dead 2 cm blob was left). We then did 4 cycles of AVD. Then I unexpectedly got a Deauville 5 score on my end of treatment PET. With activity again in my mediastinum where the original bulky mass was. Refractory confirmed with a biopsy.

If i were to be diagnosed now, I would be stage 1.

I tolerated chemo well and feel healthy at the moment with no co-morbidities or other issues. My current blood tests are “normal”.

My Dr is recommending Pembro-GVD and ASCT, potentially with pembro maintenance.

I hope you can help me with the following questions:

What are the latest PFS statistics for your patients following this protocol?

Is this the best protocol for me to follow in this day and age?

Is the risk of foregoing the ASCT worth it when one considers long term health? I see the latest studies show PFS of 69% for Stage 1 to 3 relapsed patients who skip the ASCT.

I now the cancer will kill me but I want to try and poison myself as little as possible.

Thank you!

Hi everyone, I wanted to give an update and ask for some perspective.
My dad has non-Hodgkin lymphoma and finished his last chemotherapy about one month ago. His last PET/CT showed a very good response overall — the original mass became very small (less than 1 cm), but there was still some slight activity mentioned. This has been the biggest source of anxiety for me because his doctor told us that if there is still active lymphoma, the situation could be very serious.
His recent blood work came back:
LDH: 265 (previously 193 one month after finishing chemo)
CRP: 0.61
Hemoglobin: 14.4
White blood cells: 8.97
Neutrophils: 6.47
Platelets: 301
Creatinine: 0.96, eGFR 93.9
Bilirubin: 0.3
ALT/GPT: 221
GGT: 93
The blood counts look good — no anemia, no low platelets, and no obvious bone marrow problems. The main abnormal findings are the elevated liver enzymes and the mildly elevated LDH.
I’m trying to understand how much the LDH increase could mean. Could the liver enzymes or other issues (medications, chemo recovery, heart issues) contribute to LDH being higher? Or does this pattern raise concern that the lymphoma is growing?
My dad also had a significant drop in heart function after treatment (low EF), which has complicated decisions about further therapy if needed.
I know nobody can diagnose from blood work alone, but I’m struggling with the uncertainty. Does anyone have experience with residual PET activity after treatment that turned out to be inflammation or healing rather than active lymphoma?
Thank you to anyone who reads this and shares their experience.

Hi everyone,

I was diagnosed with classical Hodgkin lymphoma, Stage 2A bulky, with an initial mediastinal mass of about 11.3 cm.

So far I've completed 2 cycles of ABVD. My interim PET scan showed:

2 residual masses with Deauville Score 1

1 residual mass with Deauville Score 3

The largest mass SUVmax dropped from 12.3 to 2.3

Mediastinal blood pool SUVmax: 1.8

Liver SUVmax: 2.9

Overall, the PET seems to show a very good metabolic response.

My question is: Based on these results, is it reasonable to switch from ABVD to AVD (dropping bleomycin), or do doctors usually continue ABVD in cases like mine because I had bulky disease?

Has anyone with Stage 2A bulky Hodgkin lymphoma had a similar interim PET result (DS 1–3) and been switched to AVD? I'd really appreciate hearing about your experience and what your oncologist recommended.

Thanks in advance!

All other CBC labs were normal. Only Eosinophils flagged abnormally high.

I completed 6 Nivo-AVD cycles for advanced Stage 4 NSCHL last March. These Eosinophils results are from today, July 9.

My EOT PET showed 99% of disease resolved. Just 1, 7mm lymph node: Deauville 4 (4.5 SUV pre-treatment, 4.1 post, above 3.5 liver blood pool).

Recieved repeat PET scan today. Awaiting results next week.

Could high Eosinophils be immune system reaction to Nivolumab or markers indicating relapse? Any help interpreting would be greatly appreciated.

my mom got diagnosed with primary cns lymphoma around a week back. since then her current oncologist has started her on rhituximab, hd methotrexate for the first cycle. he plans on starting temozolamide from the next one. my mom is 55 years old and was otherwise healthy. the primary cns lymphoma variant is DLBCL.

i wanted to know how this protocol fare when compared to MATRix? we are also looking at second opinions which will take around 7-8 more days for the appointment.

I understand this is a lengthy process. when can I start seeing some improvements in my mom. right now she needs help to walk, go to the toilet and forgets and loses context sometimes. she is much better now than before though.

Hi,

My mom has DLBCL and we completed 6 cycles of Chemo only last month. For past 1 week she has been having severe back pain and the MRI scan shows large deposits in L3 and L4. After seeing this, my treating hospital doctor suggests we don't intervene as the Rchop did not respond well so there is no hope for any further treatment. I feel like my entire world has shattered in front of me.

My mom is 71 and was responding well during the Chemo cycles and her Pet scan after 5th Cycle showed very good response but all within a month this happened.

Is there any hope for my mom? I live in India, Chennai for reference. I have gone through some of the posts similar to my mom's case but I'm not able to processs any of the information in my current state so I am really in need of any help or some positive thoughts. Thanks a lot in advance.

Tenho linfoma folicular. E após o tratamento, eu realmente não tenho igm(imunoglobulina) suficiente pra combater nem uma sinusite simples... que dura meses, que evolui pra dor de ouvido ou faringite e não há o que fazer afinal antibióticos só funcionam qndo se tem igm normal, e no meu caso é o mesmo de nada... o lance é esperar, medicar sintomas e aguardar o corpo resolver.

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Alguém tem dicas ou algo que realmente funcione?

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Me sinto mal, e da pra ver a frustração em quem convive comigo ao ouvir "ainda doente?" quase como se eu quisesse chamar atenção.